1. Neurofilament light increases over time in severe COVID-19 and is associated with delirium
- Author
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Smeele, Patrick J., Vermunt, Lisa, Blok, Siebe, Duitman, Jan Willem, Nossent, Esther J., van Agtmael, Michiel A., Heunks, Leo M. A., Horn, Janneke, Bogaard, Harm Jan, Teunissen, Charlotte E., van Agtmael, Michiel, Algera, Anne Geke, Appelman, Brent, van Baarle, Frank, Bax, Diane, Beudel, Martijn, Bomers, Marije, Bonta, Peter, Bos, Lieuwe, Botta, Michela, de Brabander, Justin, de Bree, Godelieve, de Bruin, Sanne, Buis, David T. P., Bugiani, Marianna, Bulle, Esther, Chekrouni, Nora, Chouchane, Osoul, Cloherty, Alex, Dijkstra, Mirjam, Dongelmans, Dave A., Duijvelaar, Erik, Dujardin, Romein W. G., Elbers, Paul, Fleuren, Lucas, Geerlings, Suzanne, Geijtenbeek, Theo, Girbes, Armand, Goorhuis, Bram, Grobusch, Martin P., Hafkamp, Florianne, Hagens, Laura, Hamann, Jorg, Harris, Vanessa, Hemke, Robert, Hermans, Sabine M., Heunks, Leo, Hollmann, Markus, Hovius, Joppe W., de Jong, Menno D., Koning, Rutger, Lim, Endry H. T., van Mourik, Niels, Nellen, Jeaninne, Olie, Sabine, Paulus, Frederique, Peters, Edgar, Pina-Fuentes, Dan A. I., van der Poll, Tom, Preckel, Bennedikt, Raasveld, Jorinde, Reijnders, Tom, de Rotte, Maurits C. F. J., Schippers, Job R., Schinkel, Michiel, Schultz, Marcus J., Schrauwen, Femke A. P., Schuurman, Alex, Schuurmans, Jaap, Sigaloff, Kim, Slim, Marleen A., Smeele, Patrick, Smit, Marry, Stijnis, Cornelis S., Stilma, Willemke, Thoral, Patrick, Tsonas, Anissa M., Tuinman, Pieter R., van der Valk, Marc, Veelo, Denise, Volleman, Carolien, de Vries, Heder, Vught, Lonneke A., van Vugt, Michéle, Wouters, Dorien, Zwinderman, A. H., Brouwer, Matthijs C., Wiersinga, W. Joost, Vlaar, Alexander P. J., van de Beek, Diederik, Clinical chemistry, Amsterdam Neuroscience - Neurodegeneration, Pulmonary medicine, CCA - Cancer Treatment and quality of life, ACS - Pulmonary hypertension & thrombosis, Amsterdam Neuroscience - Neuroinfection & -inflammation, Internal medicine, AII - Infectious diseases, AII - Inflammatory diseases, Intensive care medicine, ACS - Diabetes & metabolism, Medical Microbiology and Infection Control, Graduate School, Intensive Care Medicine, Pulmonology, 01 Internal and external specialisms, Experimental Immunology, ANS - Neuroinfection & -inflammation, Center of Experimental and Molecular Medicine, Neurology, ANS - Neurodegeneration, ACS - Heart failure & arrhythmias, Infectious diseases, APH - Aging & Later Life, APH - Global Health, ACS - Amsterdam Cardiovascular Sciences, Genetic Metabolic Diseases, APH - Quality of Care, AII - Amsterdam institute for Infection and Immunity, Global Health, APH - Health Behaviors & Chronic Diseases, Radiology and Nuclear Medicine, AMS - Musculoskeletal Health, AMS - Sports, APH - Methodology, Anesthesiology, ACS - Microcirculation, Medical Microbiology and Infection Prevention, ANS - Amsterdam Neuroscience, Nursing, Laboratory for General Clinical Chemistry, APH - Digital Health, APH - Personalized Medicine, Epidemiology and Data Science, and Laboratory Medicine
- Subjects
delirium ,TNF-α ,neurofilament light ,General Engineering ,COVID-19 ,SOFA - Abstract
Neurological monitoring in sedated Intensive Care Unit patients is constrained by the lack of reliable blood-based biomarkers. Neurofilament light is a cross-disease biomarker for neuronal damage with potential clinical applicability for monitoring Intensive Care Unit patients. We studied the trajectory of neurofilament light over a month in Intensive Care Unit patients diagnosed with severe COVID-19 and explored its relation to clinical outcomes and pathophysiological predictors. Data were collected over a month in 31 Intensive Care Unit patients (166 plasma samples) diagnosed with severe COVID-19 at Amsterdam University Medical Centre, and in the first week after emergency department admission in 297 patients with COVID-19 (635 plasma samples) admitted to Massachusetts General hospital. We observed that Neurofilament light increased in a non-linear fashion in the first month of Intensive Care Unit admission and increases faster in the first week of Intensive Care Unit admission when compared with mild-moderate COVID-19 cases. We observed that baseline Neurofilament light did not predict mortality when corrected for age and renal function. Peak neurofilament light levels were associated with a longer duration of delirium after extubation in Intensive Care Unit patients. Disease severity, as measured by the sequential organ failure score, was associated to higher neurofilament light values, and tumour necrosis factor alpha levels at baseline were associated with higher levels of neurofilament light at baseline and a faster increase during admission. These data illustrate the dynamics of Neurofilament light in a critical care setting and show associations to delirium, disease severity and markers for inflammation. Our study contributes to determine the clinical utility and interpretation of neurofilament light levels in Intensive Care Unit patients.
- Published
- 2021